Imagine you’re a patient just returning from the hospital. The nurse’s instructions say one thing. The brochure from the doctor’s office says another. Which one do you listen to? And how does it make you feel about the care you just received?
Several clinical areas across the Health System are addressing inconsistencies just like these.
“A lot goes into the cleaning, care and replacement of respiratory equipment for cystic fibrosis patients, and a lot of it is different for these patients than asthma and COPD patients, such as the need to rinse nebulizers in sterile water,” says Paulette Ratkiewicz, respiratory therapy supervisor, whose area takes care of more than 300 pediatric CF patients on a regular basis.
Two years ago, patients were getting individual sheets of paper from various parts of the Health System with conflicting information. Today, thanks to a Patient Education Advisory Committee grant, The Cystic Fibrosis Guidebook is given to every CF patient at Mott.
“Everything in it is in line with Cystic Fibrosis Foundation Guidelines. Patients and families can look at this and be confident they’re doing the right thing,” she says.
Throughout Mott Children’s Hospital, a team of advanced practice nurses and respiratory therapists came together to create the Trach Teaching Team. They teach families the ins and outs of taking care of the trachea and equipment, and use a 60-page book created by the Peds Otolaryngology staff which helps parents continue that intricate care when they leave the hospital.
“The book translates our care into the home setting and into the community by helping home care staff and the patients’ schools as well,” says Cathy Lewis, MSN, RN, clinical nurse specialist.
“Everyone who gets a trach gets the training and the book—even patients who transfer from other facilities,” says Lewis. “This kind of teaching is essential for safe care at home, and we plan to keep doing it.”
When CVC5 Nurse Manager Joan McNeice set into motion a lean project that looked at lowering hospital length of stay (LOS) for their amputation patients, their lean team invited patients and families and any member of the healthcare team that touches the life of a limb loss patient to collaborative meetings.
They learned that several clinical disciplines gave patients and families a piece of the education puzzle but that nursing did not know what patients were learning along the way.
“We also found that patients and families received most of their education materials on the day of discharge,” says Kimberly Newcomb-Forro, RN. “It was just too overwhelming.”
The team redesigned the amputation clinical pathway, which guides what clinical care is provided day to day, and the patient education binder, which now tells patients and families everything that will happen on a color-coded, day-by-day basis.
“Education is now spread throughout the patient’s entire stay,” says Newcomb-Forro.
How have the new materials affected LOS? CVC5’s average LOS dropped from 19.3 days to 9.4 days in the period from 2009 to 2011. In addition, their 30-day readmission is showing improvement.